Pulmonary Function Testing: Concepts and Clinical Applications. Potential Conflict Of Interest. Objectives. Rationale: Why Test?
|
|
- Elisabeth Jackson
- 6 years ago
- Views:
Transcription
1 Pulmonary Function Testing: Concepts and Clinical Applications David M Systrom, MD Potential Conflict Of Interest Nothing to disclose pertinent to this presentation BRIGHAM AND WOMEN S HOSPITAL Harvard Medical School Objectives Understand common indications for testing Review components of PFTs Recognize patterns of PFT abnormalities in disease Gain familiarity with interpretation strategies Rationale: Why Test? Evaluate symptoms/signs of respiratory disease Monitor course of disease and response to therapy Prognosticate Screen patients at risk pre-operative systemic disease or systemic therapy with known pulmonary effects occupational exposure Evaluate disability Components of Pulmonary Function Testing Routine Exhaled volume and flow rates -spirometry Lung volumes-helium dilution or plethysmography Diffusion characteristics -diffusion capacity Airway reactivity-bronchodilator response or methacholine challenge Oxygenation/Ventilation-pulse oximetry or arterial blood gas analysis Components of Pulmonary Function Testing Specialized Respiratory muscle strength-maximal inspiratory and expiratory pressures (MIPs and MEPs) Heart-lung interaction-integrated integrated cardiopulmonary exercise testing Novel assays of exhaled gas
2 Spirometry Most basic and widely used formal pulmonary function test Easily performed in the office setting Part of the initial evaluation of patients with undiagnosed chest complaints Sensitive and specific test for the presence of airflow obstruction as may occur in asthma, COPD, bronchiectasis Less specific test for restrictive lung disease FVC FEV FEV 1 /FVC PEFR y/o Man with Dyspnea A. Obstruction due to the reduced B. Restriction due to the reduced FVC C. Obstruction due to the reduced FEV 1 /FVC D. Inadequate effort on the basis of marked expiratory coving of the flow-volume loop FVC FEV FEV 1 /FVC PEFR y/o Man with Dyspnea Spirometry Spirometry measures inhaled and exhaled gas volumes and gas flows during a forced vital capacity maneuver A. Obstruction due to the reduced B. Restriction due to the reduced FVC C. Obstruction due to the reduced FEV 1 /FVC D. Inadequate effort on the basis of marked expiratory coving of the flow-volume loop Definitions and Terms FEV 1 -forced expiratory volume in the first second FVC -forced vital capacity FEV 1 /FVC-ratio of the FEV 1 to FVC (as a %) - average forced expiratory flow during the mid portion of the FVC PEFR-peak expiratory flow rate Definition of Normal Values Predicted values are standardized to age, sex, height, and race; measured values are expressed as a percentage of predicted Current ATS guidelines suggest that values below the 95% CI be considered abnormal This recommendation has not been universally adopted
3 22 y/o Woman with Wheezing and Chest Tightness FVC FEV FEV 1 /FVC PEFR FEF A. Obstruction due to the reduced PEFR B. Restriction due to the reduced FVC and FEV 1 C. Obstruction on the basis of marked expiratory coving of the flow-volume loop D. Obstruction due to the reduced FEV 1 /FVC 22 y/o Woman with Wheezing and Chest Tightness FVC FEV FEV 1 /FVC PEFR FEF A. Obstruction due to the reduced PEFR B. Restriction due to the reduced FVC and FEV 1 C. Obstruction on the basis of marked expiratory coving of the flow-volume loop D. Obstruction due to the reduced FEV 1 /FVC Spirometry- Obstructive pattern Limitation to expiratory flow characterized by reduced FEV 1, relatively preserved FVC, reduced FEV 1 /FVC Emphysema loss of elastic recoil Chronic bronchitis mucus hypersecretion mucosal thickening bronchospasm Asthma smooth muscle contraction airway edema Bronchiolitis mucosal inflammation 22 y/o Woman with Wheezing and Chest Tightness FVC FEV FEV 1 /FVC PEFR What should be ordered next? A. diffusion capacity B. post-bronchodilator spirometry C. methacholine challenge D. ambulatory peak flow monitoring E. allergen skin testing 22 y/o Woman with Wheezing and Chest Tightness FVC FEV FEV 1 /FVC PEFR What should be ordered next? A. diffusion capacity B. post-bronchodilator spirometry C. methacholine challenge D. ambulatory peak flow monitoring E. allergen skin testing Bronchodilator Testing Assessment of lung function (spirometry) pre- and 15 minutes post- administration of a bronchodilator document reversible airflow obstruction asthma diagnosis prognosticate in COPD may imply an increased likelihood of response to CS immediate feedback to patients may increase compliance lack of an acute response does not imply lack of response to long-term therapy
4 22 y/o Woman-Bronchodilator Response % pred post %change FVC FEV FEV 1 /FVC PEFR Positive response: 12% increase in FEV 1 or FVC, and an increase of 200 cc Bronchodilator Testing When to test suspected new diagnosis of obstructive lung disease asthma, COPD, emphysema, bronchiolitis, bronchiectasis f/u to assess efficacy of treatment corticosteroids and long-acting bronchodilators (salmeterol) may alter bronchodilator response 38 y/o Man with Episodic Cough 38 y/o Man with Episodic Cough Close friend recently hospitalized with asthma Spirometry: FVC FEV FEV 1 /FVC PEFR What should be ordered next to r/o asthma? A. diffusion capacity B. post-bronchodilator spirometry C. methacholine challenge D. ambulatory peak flow monitoring E. allergen skin testing Close friend recently hospitalized with asthma Spirometry: FVC FEV FEV 1 /FVC PEFR What should be ordered next to r/o asthma? A. diffusion capacity B. post-bronchodilator spirometry C. methacholine challenge D. ambulatory peak flow monitoring E. allergen skin testing Bronchial Challenge Testing Bronchial challenge testing detects airway hyper- reactivity as may occur in asthma, COPD, and bronchiectasis Methacholine is administered by nebulizer in increasing concentrations spirometry is measured at baseline and after each concentration. the degree of airflow obstruction present after any given concentration is a reflection of airway reactivity patients with hyper-reactive reactive airways will bronchoconstrict at lower concentrations FEV 1 (% baseline) Bronchial Challenge Testing Hyper-reactive PC 20 = 6.2 mg/ml McH (mg/ml) FEV 1 (% baseline) Non-reactive PC 20 =? McH (mg/ml)
5 Bronchial Challenge Testing The concentration required to induce a 20 % fall in FEV 1 (PC 20 ) is reported. < 8 mg/ml is hyper- reactive Airway hyper-reactivity reactivity may be present in ~15% of normal A negative methacholine challenge excludes asthma in the absence of concurrent therapy with: corticosteroids (6 wks) leukotriene modifiers (48 hours) long-acting bronchodilators (48 hours) theophyline (1 week) cromolyn (1 week) Bronchial Challenge Testing Indications suspicion of asthma with normal spirometry and a negative bronchodilator response chronic cough nocturnal cough episodic chest tightness unexplained exercise intolerance recurrent bronchitis 30 y/o Man with Dyspnea and Cough Spirometry: FVC FEV FEV 1 /FVC PEFR A. Suggested obstruction due to the reduced PEFR B. Restriction due to the increased FEV 1 /FVC C. Obstruction on the basis of the reduced FEV 1 D. Suggested restriction due to the reduced FEV 1 and FVC 30 y/o Man with Dyspnea and Cough Spirometry: FVC FEV FEV 1 /FVC PEFR A. Suggested obstruction due to the reduced PEFR B. Restriction due to the increased FEV 1 /FVC C. Obstruction on the basis of the reduced FEV 1 D. Suggested restriction due to the reduced FEV 1 and FVC Spirometry: Restrictive pattern Reduction in gas volume of the chest characterized by symmetric reduction in FEV 1 and FVC; FEV 1 /FVC is preserved reduced chest wall compliance loss of parenchyma (i.e. s/p resection) increased parenchymal stiffness respiratory muscle weakness Spirometry can measure only exhaled gas, not the total gas in the chest; it can only suggest a diagnosis of restriction Absolute Lung Volumes After complete exhalation, residual air remains in the lung (RV) Without quantification of the RV, the total volume of gas in the chest (TLC) cannot be determined Direct measurement of lung volumes is necessary for the formal diagnosis of restriction
6 Measurement of the residual volume (RV) Significance of the TLC and RV Helium dilution Plethysmography A reduction in TLC defines restriction which may have only been suggested by a reduced FVC A normal TLC excludes restriction which may have been suggested by a reduced FVC measured by spirometry An elevated RV indicates gas trapping as can be seen in severe obstructive lung disease 30 y/o Man with Dyspnea and Cough Spirometry: FVC FEV FEV 1 /FVC PEFR TLC Suggested restriction due to the reduced FEV 1 and FVC Confirmed restriction due to the reduced TLC Diffusing Capacity (D L ) quantifies the transfer of oxygen from alveolar gas to the red cell The quantity and rate of oxygen transfer depends on area (A)( ) of the alveolar- capillary membrane thickness (T)( driving pressure (ΔPo( 2 ) A ΔPo 2 DL = T Abnormalities in DLD CO Increased DLD CO supine position polycythemia alveolar hemorrhage left-to to-right shunt early CHF asthma Decreased DLD CO decreased area emphysema, s/p resection, pulmonary emboli/htn anemia increased thickness pulmonary fibrosis, pneumonconiosis,, sarcoid, drug-induced lung disease, CHF increased CO back- pressure cigarette smoking Abnormalities in TLC/DL CO FVC 1.12 (19%) FEV (21%) FEV 1 /FVC.93 (100%) TLC 2.10 (28%) DL CO /V A 15 (43%) A. Emphysema B. Interstitial lung disease C. Diaphragmatic dysfunction D. Primary pulmonary hypertension
7 Abnormalities in TLC/DL CO FVC 1.12 (19%) FEV (21%) FEV 1 /FVC.93 (100%) TLC 2.10 (28%) DL CO /V A 15 (43%) A. Emphysema B. Interstitial lung disease C. Diaphragmatic dysfunction D. Primary pulmonary hypertension Abnormalities in TLC/DL CO 37 y/o woman TLC 3.35 (71%) FVC 1.98 (57%) FEV (58%) FEV 1 /FVC.86 (100%) DL CO /V A 24 (110%) Neuro-muscular weakness or Thoracic deformity Abnormalities in TLC/DL CO 49 y/o woman TLC 4.81 (102%) FVC 2.90 (92%) FEV (90%) FEV 1 /FVC.82 (100%) DL CO /V A 10 (42%) Pulmonary vascular disease Hyperinflation vs. combined defect Interpretation Algorithm Obstruction? FVC low Yes No Acceptable spirogram? FEV 1 /FVC ratio low Yes Pure obstruction? Reversible with Further testing* β agonist/ Incr NO Yes No Asthma COPD No No Obstruction? FVC low Yes No Prob. Restriction Normal Further testing* * lung volumes/dl CO Interpretation Algorithm: Lung Volumes and D L CO Total Lung Capacity Low NL D L CO D L CO Low* NL Low NL Interstitial process *D L /V A < ~100% pred S/p Resection Thoracic Deformity Muscle Weakness Obesity Pulmonary Vascular Disease Normal Summary Pulmonary function testing is an essential component of the evaluation of patients with respiratory complaints Spirometry can document obstruction (through the FEV 1 /FVC ratio) and suggest restriction Novel measures of exhaled gas may assist in the diagnosis of asthma Lung volumes and DLD CO are indicated to diagnose and differentiate restrictive and vascular abnormalities
8
Pulmonary Function Testing The Basics of Interpretation
Pulmonary Function Testing The Basics of Interpretation Jennifer Hale, M.D. Valley Baptist Family Practice Residency Objectives Identify the components of PFTs Describe the indications Develop a stepwise
More informationBasic approach to PFT interpretation. Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic
Basic approach to PFT interpretation Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic Disclosures Received honorarium from Astra Zeneca for education presentations Tasked Asked
More informationWhat do pulmonary function tests tell you?
Pulmonary Function Testing Michael Wert, MD Assistant Professor Clinical Department of Internal Medicine Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical
More informationPFT Interpretation and Reference Values
PFT Interpretation and Reference Values September 21, 2018 Eric Wong Objectives Understand the components of PFT Interpretation of PFT Clinical Patterns How to choose Reference Values 3 Components Spirometry
More informationPULMONARY FUNCTION TESTS
Chapter 4 PULMONARY FUNCTION TESTS M.G.Rajanandh, Department of Pharmacy Practice, SRM College of Pharmacy, SRM University. OBJECTIVES Review basic pulmonary anatomy and physiology. Understand the reasons
More informationPulmonary Function Tests. Mohammad Babai M.D Occupational Medicine Specialist
Pulmonary Function Tests Mohammad Babai M.D Occupational Medicine Specialist www.drbabai.com Pulmonary Function Tests Pulmonary Function Tests: Spirometry Peak-Flow metry Bronchoprovocation Tests Body
More informationTeacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology
Title: Spirometry Teacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology I. Measurements of Ventilation Spirometry A. Pulmonary Volumes 1. The tidal
More informationPulmonary Function Testing. Ramez Sunna MD, FCCP
Pulmonary Function Testing Ramez Sunna MD, FCCP Lecture Overview General Introduction Indications and Uses Technical aspects Interpretation Patterns of Abnormalities When to perform a PFT 1. Evaluation
More informationCoexistence of confirmed obstruction in spirometry and restriction in body plethysmography, e.g.: COPD + pulmonary fibrosis
Volumes: IRV inspiratory reserve volume Vt tidal volume ERV expiratory reserve volume RV residual volume Marcin Grabicki Department of Pulmonology, Allergology and Respiratory Oncology Poznań University
More informationPulmonary Pearls. Medical Pearls. Case 1: Case 1 (cont.): Case 1: What is the Most Likely Diagnosis? Case 1 (cont.):
Pulmonary Pearls Christopher H. Fanta, MD Pulmonary and Critical Care Division Brigham and Women s Hospital Partners Asthma Center Harvard Medical School Medical Pearls Definition: Medical fact that is
More information6- Lung Volumes and Pulmonary Function Tests
6- Lung Volumes and Pulmonary Function Tests s (PFTs) are noninvasive diagnostic tests that provide measurable feedback about the function of the lungs. By assessing lung volumes, capacities, rates of
More informationInterpreting pulmonary function tests: Recognize the pattern, and the diagnosis will follow
REVIEW FEYROUZ AL-ASHKAR, MD Department of General Internal Medicine, The Cleveland Clinic REENA MEHRA, MD Department of Pulmonary and Critical Care Medicine, University Hospitals, Cleveland PETER J. MAZZONE,
More informationRESPIRATORY PHYSIOLOGY Pre-Lab Guide
RESPIRATORY PHYSIOLOGY Pre-Lab Guide NOTE: A very useful Study Guide! This Pre-lab guide takes you through the important concepts that where discussed in the lab videos. There will be some conceptual questions
More informationBasic mechanisms disturbing lung function and gas exchange
Basic mechanisms disturbing lung function and gas exchange Blagoi Marinov, MD, PhD Pathophysiology Department, Medical University of Plovdiv Respiratory system 1 Control of breathing Structure of the lungs
More informationPulmonary Function Testing
Pulmonary Function Testing Let s catch our breath Eddie Needham, MD, FAAFP Program Director Emory Family Medicine Residency Program Learning Objectives The Astute Learner will: Become familiar with indications
More informationSpirometry. Obstruction. By Helen Grim M.S. RRT. loop will have concave appearance. Flows decreased consistent with degree of obstruction.
1 2 Spirometry By Helen Grim M.S. RRT 3 4 Obstruction loop will have concave appearance. Flows decreased consistent with degree of obstruction. Volumes may be normal, but can decrease with severity of
More informationLecture Notes. Chapter 3: Asthma
Lecture Notes Chapter 3: Asthma Objectives Define asthma and status asthmaticus List the potential causes of asthma attacks Describe the effect of asthma attacks on lung function List the clinical features
More informationS P I R O M E T R Y. Objectives. Objectives 2/5/2019
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationLung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects
Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects Use of GOLD and ATS Criteria Connie Paladenech, RRT, RCP, FAARC Benefits and Limitations of Pulmonary Function Testing Benefits
More informationA Primer on Reading Pulmonary Function Tests. Joshua Benditt, M.D.
A Primer on Reading Pulmonary Function Tests Joshua Benditt, M.D. What Are Pulmonary Function Tests Used For? Pulmonary function testing provides a method for objectively assessing the function of the
More informationRespiratory Disease. Dr Amal Damrah consultant Neonatologist and Paediatrician
Respiratory Disease Dr Amal Damrah consultant Neonatologist and Paediatrician Signs and Symptoms of Respiratory Diseases Cardinal Symptoms Cough Sputum Hemoptysis Dyspnea Wheezes Chest pain Signs and Symptoms
More informationS P I R O M E T R Y. Objectives. Objectives 3/12/2018
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
More informationAssessment of the Lung in Primary Care
Assessment of the Lung in Primary Care Andrew G Veale FRACP Auckland, New Zealand Presentation Cough (productive or dry) Haemoptysis Shortness of breath / dyspnea Wheeze (or noisy breathing) Chest pain
More informationPULMONARY FUNCTION. VOLUMES AND CAPACITIES
PULMONARY FUNCTION. VOLUMES AND CAPACITIES The volume of air a person inhales (inspires) and exhales (expires) can be measured with a spirometer (spiro = breath, meter = to measure). A bell spirometer
More informationPULMONARY FUNCTION TESTING. Purposes of Pulmonary Tests. General Categories of Lung Diseases. Types of PF Tests
PULMONARY FUNCTION TESTING Wyka Chapter 13 Various AARC Clinical Practice Guidelines Purposes of Pulmonary Tests Is lung disease present? If so, is it reversible? If so, what type of lung disease is present?
More informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More informationThe Aging Lung. Sidney S. Braman MD FACP FCCP Professor of Medicine Brown University Providence RI
The Aging Lung Sidney S. Braman MD FACP FCCP Professor of Medicine Brown University Providence RI Is the respiratory system of the elderly different when compared to younger age groups? Respiratory Changes
More informationObjectives. Pulmonary Assessment 12/13/2017
Pulmonary Assessment Reid Blackwelder, MD, FAAFP Professor and Chair, Family Medicine Quillen Colege of Medicine, ETSU Objectives Understand anatomy and physiology of pulmonary assessment techniques Remember
More informationLab 4: Respiratory Physiology and Pathophysiology
Lab 4: Respiratory Physiology and Pathophysiology This exercise is completed as an in class activity and including the time for the PhysioEx 9.0 demonstration this activity requires ~ 1 hour to complete
More informationSpirometry: Introduction
Spirometry: Introduction Dr. Badri Paudel 1 2 GMC Spirometry Spirometry is a method of assessing lung function by measuring the volume of air the patient can expel from the lungs after a maximal expiration.
More informationChapter 3. Pulmonary Function Study Assessments. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 3 Pulmonary Function Study Assessments 1 Introduction Pulmonary function studies are used to: Evaluate pulmonary causes of dyspnea Differentiate between obstructive and restrictive pulmonary disorders
More informationThe role of lung function testing in the assessment of and treatment of: AIRWAYS DISEASE
The role of lung function testing in the assessment of and treatment of: AIRWAYS DISEASE RHYS JEFFERIES ARTP education Learning Objectives Examine the clinical features of airways disease to distinguish
More informationContent Indica c tion Lung v olumes e & Lung Indica c tions i n c paci c ties
Spirometry Content Indication Indications in occupational medicine Contraindications Confounding factors Complications Type of spirometer Lung volumes & Lung capacities Spirometric values Hygiene &
More informationRespiratory System Mechanics
M56_MARI0000_00_SE_EX07.qxd 8/22/11 3:02 PM Page 389 7 E X E R C I S E Respiratory System Mechanics Advance Preparation/Comments 1. Demonstrate the mechanics of the lungs during respiration if a bell jar
More informationMedicine Dr. Kawa Lecture 1 Asthma Obstructive & Restrictive Pulmonary Diseases Obstructive Pulmonary Disease Indicate obstruction to flow of air
Medicine Dr. Kawa Lecture 1 Asthma Obstructive & Restrictive Pulmonary Diseases Obstructive Pulmonary Disease Indicate obstruction to flow of air through the airways. As asthma, COPD ( chronic bronchitis
More informationPulmonary Function Testing
In the Clinic Pulmonary Function Testing Hawa Edriss MD, Gilbert Berdine MD The term PFT encompasses three different measures of lung function: spirometry, lung volumes, and diffusion capacity. In this
More informationAnyone who smokes and/or has shortness of breath and sputum production could have COPD
COPD DIAGNOSIS AND MANAGEMENT CHECKLIST Anyone who smokes and/or has shortness of breath and sputum production could have COPD Confirm Diagnosis Presence and history of symptoms: Shortness of breath Cough
More informationAir Flow Limitation. In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation.
Asthma Air Flow Limitation In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation. True whether reversible, asthma and exercise-induced bronchospasm,
More informationKnown Allergies: Shellfish. Symptoms: abdominal pain, nausea, diarrhea, or vomiting. congestion, trouble breathing, or wheezing.
CSTAR CASE STUDIES: BLOCK B Asthma or COPD? Setting: Walk in clinic. Dan: I havi g that cough thi g agai HPI: Dan is a 49-year-old male teacher who reports having had episodes of cough with mucus production
More informationUnderstanding the Basics of Spirometry It s not just about yelling blow
Understanding the Basics of Spirometry It s not just about yelling blow Carl D. Mottram, RRT RPFT FAARC Technical Director - Pulmonary Function Labs and Rehabilitation Associate Professor of Medicine -
More informationPulmonary Function Test
Spirometry: Introduction Dr. Badri Paudel GMC Spirometry Pulmonary Function Test! Spirometry is a method of assessing lung function by measuring the volume of air the patient can expel from the lungs after
More informationRESPIRATORY CARE IN GENERAL PRACTICE
RESPIRATORY CARE IN GENERAL PRACTICE Definitions of Asthma and COPD Asthma is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they
More informationSPIROMETRY TECHNIQUE. Jim Reid New Zealand
Jim Reid New Zealand The Basics Jim Reid Spirometry measures airflow and lung volumes, and is the preferred lung function test in COPD. By measuring reversibility of obstruction, it is also diagnostic
More informationLUNG FUNCTION TESTING: SPIROMETRY AND MORE
LUNG FUNCTION TESTING: SPIROMETRY AND MORE OBJECTIVES 1. To describe other lung function testing for toddlers and those who cannot perform spirometry 2. To describe a lung function test on infants 3. To
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationPerforming a Methacholine Challenge Test
powder for solution, for inhalation Performing a Methacholine Challenge Test Provocholine is a registered trademark of Methapharm Inc. Copyright Methapharm Inc. 2016. All rights reserved. Healthcare professionals
More informationSpirometry in primary care
Spirometry in primary care Wednesday 13 th July 2016 Dr Rukhsana Hussain What is spirometry? A method of assessing lung function Measures volume of air a patient can expel after a full inspiration Recorded
More informationClinical pulmonary physiology. How to report lung function tests
Clinical pulmonary physiology or How to report lung function tests Lung function testing A brief history Why measure? What can you measure? Interpretation/ reporting Examples and case histories Exercise
More informationQuestion by Question (QXQ) Instructions for the Pulmonary Diagnosis Form (PLD)
Question by Question (QXQ) Instructions for the Pulmonary Diagnosis Form (PLD) A Pulmonary Diagnosis Form is filled out by the reviewer for all medical records that are sent to them for review by the CSCC.
More informationSPIROMETRY. Marijke Currie (CRFS) Care Medical Ltd Phone: Copyright CARE Medical ltd
SPIROMETRY Marijke Currie (CRFS) Care Medical Ltd Phone: 0800 333 808 Email: sales@caremed.co.nz What is spirometry Spirometry is a physiological test that measures the volume of air an individual can
More informationThe adult with recurrent breathlessness. A/Prof Gerald Chua Medicine NTFGH
The adult with recurrent breathlessness A/Prof Gerald Chua Medicine NTFGH Dyspnoea Subjective experience of breathing discomfort Variable among individuals with apparently similar degrees of impairment
More informationAsthma. UVM. University of Vermont. Alicia Jacobs MD Fletcher Allen Health Care and the University of Vermont
University of Vermont ScholarWorks @ UVM Family Medicine Scholarly Works 6-14-2013 Asthma Alicia Jacobs MD Fletcher Allen Health Care and the University of Vermont Follow this and additional works at:
More informationPULMONARY FUNCTION TESTING. By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)
PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS) PULMONARY FUNCTION TESTS CATEGORIES Spirometry Lung volumes
More informationAsthma in the Athlete
Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with
More informationLife-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
More informationPulmonary Func-on Tes-ng. Chapter 8
Pulmonary Func-on Tes-ng Chapter 8 Pulmonary Func-on Tes-ng Which of the following is the true pulmonary func-on test? Spirometry Lung volumes Diffusion capacity ABG Pulmonary Func-on Tes-ng Process of
More informationCOPD. Dr.O.Paknejad Pulmonologist Shariati Hospital TUMS
IN THE NAME OF GOD COPD Dr.O.Paknejad Pulmonologist Shariati Hospital TUMS Definition of COPD* COPD is a preventable and treatable chronic lung disease characterized by airflow limitation that is not fully
More informationAsthma Pathophysiology and Treatment. John R. Holcomb, M.D.
Asthma Pathophysiology and Treatment John R. Holcomb, M.D. Objectives Definition of Asthma Epidemiology and risk factors of Asthma Pathophysiology of Asthma Diagnostics test of Asthma Management of Asthma
More informationPulmonary Function Manual
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Scholarly Papers 1985 Pulmonary Function Manual John P. Simelaro Philadelphia College of Osteopathic Medicine, johns@pcom.edu Follow
More informationCOPD Management in LTC: Presented By: Jessica Denney RRT
COPD Management in LTC: Presented By: Jessica Denney RRT Sponsored by Z & D Medical Services, Diamond Sponsor Seizing Opportunities to Provide Individualized Treatment and Device Selection for your COPD
More informationSpirometry: an essential clinical measurement
Shortness of breath THEME Spirometry: an essential clinical measurement BACKGROUND Respiratory disease is common and amenable to early detection and management in the primary care setting. Spirometric
More informationSubject Index. Carbon monoxide (CO) disease effects on levels 197, 198 measurement in exhaled air 197 sources in exhaled air 197
Subject Index Airway resistance airflow interruption measurement in preschoolers, see Forced oscillation technique; Interrupter technique plethysmography, see Plethysmography; Whole-body plethysmography
More informationMSRC AIR Course Karla Stoermer Grossman, MSA, BSN, RN, AE-C
MSRC AIR Course Karla Stoermer Grossman, MSA, BSN, RN, AE-C Explain the importance of objective measures in the management of asthma Explain the different types of objective measures used in the management
More information7/7/2015. Somboon Chansakulporn, MD. History of variable respiratory symptoms. 1. Documented excessive variability in PFT ( 1 test)
Definition of Asthma GINA 2010: Chronic inflammatory disorder of the airways Airway hyper-responsiveness Recurrent wheezing, breathlessness, chest tightness, coughing Variable, reversible airflow obstruction
More informationUpdate on heterogeneity of COPD, evaluation of COPD severity and exacerbation
Update on heterogeneity of COPD, evaluation of COPD severity and exacerbation Yung-Yang Liu, MD Taipei Veterans General Hospital Aug 29, 2015 G O lobal Initiative for Chronic bstructive L D ung isease
More informationPDF of Trial CTRI Website URL -
Clinical Trial Details (PDF Generation Date :- Wed, 31 Oct 2018 11:13:48 GMT) CTRI Number Last Modified On 17/01/2015 Post Graduate Thesis Type of Trial Type of Study Study Design Public Title of Study
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationAsthma Management for the Athlete
Asthma Management for the Athlete Khanh Lai, MD Assistant Professor Division of Pediatric Pulmonary and Sleep Medicine University of Utah School of Medicine 2 nd Annual Sports Medicine Symposium: The Pediatric
More informationPulmo-Park Pom-Pom Shooter: Measuring the Effect of Restricted Breathing on Peak Expiratory Flow (PEF) Student Information Page Activity 5D
Pom-Pom Shooter: Measuring the Effect of Restricted Breathing on Peak Expiratory Flow (PEF) Student Information Page Activity 5D Students with asthma or other respiratory problems should not perform the
More informationبسم هللا الرحمن الرحيم
بسم هللا الرحمن الرحيم Yesterday we spoke of the increased airway resistance and its two examples: 1) emphysema, where we have destruction of the alveolar wall and thus reducing the area available for
More informationChronic Obstructive Pulmonary Disease (COPD) Clinical Guideline
Chronic Obstructive Pulmonary Disease (COPD) Clinical These clinical guidelines are designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients. They
More informationPomPom SHOOTER. Activity Background: Common Obstructive Lung Disorders:
CAUTION: Students with asthma or other respiratory problems should NOT perform the breathing exercises in this activity because they involve repeated maximal inhalations and exhalations and use of a breathing
More informationLecture Notes. Chapter 4: Chronic Obstructive Pulmonary Disease (COPD)
Lecture Notes Chapter 4: Chronic Obstructive Pulmonary Disease (COPD) Objectives Define COPD Estimate incidence of COPD in the US Define factors associated with onset of COPD Describe the clinical features
More informationCOMPREHENSIVE RESPIROMETRY
INTRODUCTION Respiratory System Structure Complex pathway for respiration 1. Specialized tissues for: a. Conduction b. Gas exchange 2. Position in respiratory pathway determines cell type Two parts Upper
More informationRespiratory Physiology In-Lab Guide
Respiratory Physiology In-Lab Guide Read Me Study Guide Check Your Knowledge, before the Practical: 1. Understand the relationship between volume and pressure. Understand the three respiratory pressures
More informationASTHMA. Epidemiology. Pathophysiology. Diagnosis. IAP UG Teaching slides
BRONCHIAL ASTHMA ASTHMA Epidemiology Pathophysiology Diagnosis 2 CHILDHOOD ASTHMA Childhood bronchial asthma is characterized by Airway obstruction which is reversible Airway inflammation Airway hyper
More informationExercise-Induced Bronchospasm. Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute
Exercise-Induced Bronchospasm Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute EIB Episodic bronchoconstriction with exercise May be an exacerbation
More informationFunction of the Respiratory System. Exchange CO2 (on expiration) for O2 (on inspiration)
Function of the Respiratory System Exchange CO2 (on expiration) for O2 (on inspiration) Upper Respiratory Tract Includes: Nose Mouth Pharynx Larynx Function: Warms and humidifies the inspired air Filters
More informationChronic obstructive lung disease. Dr/Rehab F.Gwada
Chronic obstructive lung disease Dr/Rehab F.Gwada Obstructive lung diseases Problem is in the expiratory phase Lung disease Restrictive lung disease Restriction may be with, or within the chest wall Problem
More informationOffice Spirometry Guide
Office Spirometry Guide MD Spiro 803 Webster Street, Lewiston ME 04240 Telephone 207-786-7808 1-800-588-3381 Fax 207-786-7280 www.mdspiro.com e-mail: sales@mdspiro.com Why should you perform spirometry
More informationThe Respiratory System Part II. Dr. Adelina Vlad
The Respiratory System Part II Dr. Adelina Vlad Pulmonary Ventilation Pulmonary mechanics - is the physics of the lungs, airways and chest wall - explains how the body moves air in (inspiration) and out
More informationDiagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016
Diagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016 Diagnosis: There is no lower limit to the age at which
More informationChronic Cough. Abhishek Kumar, MD, MPH Pulmonary and Critical Care Mercy Medical Center, Cedar Rapids, IA
Chronic Cough Abhishek Kumar, MD, MPH Pulmonary and Critical Care Mercy Medical Center, Cedar Rapids, IA What we shall discuss? Cough anatomy and pathophysiology Common etiologies Work-up Role of spirometry/pulmonary
More informationThe objectives of the pre-anaesthetic assessment
Dr Gerard Meachery The objectives of the pre-anaesthetic assessment! Evaluate the patient s medical condition from medical history, physical examination, investigations and, when appropriate, past medical
More informationSpirometry Workshop for Primary Care Nurse Practitioners
Spirometry Workshop for Primary Care Nurse Practitioners Catherine Casey S. Jones PhD, RN, AE-C, ANP-C Certified Adult Nurse Practitioner Texas Pulmonary & Critical Care Consultants P.A. and Adjunct Professor
More informationSpirometry: FEVER DISEASE DIABETES HOW RELIABLE IS THIS? 9/2/2010 BUT WHAT WE PRACTICE: Spirometers are objective tools
SPIROMETRY PRINCIPLES, PROCEDURE AND QA Spirometry: Dr. Rahul Kodgule CHEST RESEARCH FOUNDATION, PUNE FEVER ISCHAEMIC HEART DISEASE DIABETES BUT WHAT WE PRACTICE: Spirometers are objective tools to diagnose
More information3 COPD Recognition and Diagnosis: Approach to the Patient with Respiratory Symptoms
William L. Eschenbacher, MD 3 COPD Recognition and Diagnosis: Approach to the Patient with Respiratory Symptoms Key Points 1. Patients who present with respiratory symptoms such as cough, sputum production,
More informationYuriy Feschenko, Liudmyla Iashyna, Ksenia Nazarenko and Svitlana Opimakh
2018; 7(1): 74-78 ISSN (E): 2277-7695 ISSN (P): 2349-8242 NAAS Rating: 5.03 TPI 2018; 7(1): 74-78 2018 TPI www.thepharmajournal.com Received: 11-11-2017 Accepted: 12-12-2017 Yuriy Feschenko Liudmyla Iashyna
More informationDiagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma
Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma
More informationPeople with asthma who smoke. The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more.
COPD Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum (phlegm) production
More informationHow to treat COPD? What is the mechanism of dyspnea? Smoking cessation
: The Increasing Role of the FP Alan Kaplan, MD, CCFP(EM) Presented at the Primary Care Today: Education Conference and Medical Exposition, Toronto, Ontario, May 2006. Chronic obstructive pulmonary disease
More informationThe role of Pulmonary function Testing In Interstitial lung disease in infants. [ ipft in child ]
The role of Pulmonary function Testing In Interstitial lung disease in infants [ ipft in child ] Introduction Managing infants with diffuse lung disease (DLD) suspected to have interstitial lung disease
More informationTriennial Pulmonary Workshop 2012
Triennial Pulmonary Workshop 2012 Rod Richie, M.D., DBIM Medical Director Texas Life Insurance Company, Waco, TX EMSI, Waco, TX Lisa Papazian, M.D., DBIM Assistant Vice President and Medical Director Sun
More informationChronic inflammation of the airways Hyperactive bronchi Shortness of breath Tightness in chest Coughing Wheezing
Chronic inflammation of the airways Hyperactive bronchi Shortness of breath Tightness in chest Coughing Wheezing Components of the respiratory system Nasal cavity Pharynx Trachea Bronchi Bronchioles Lungs
More informationGINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017
GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and
More informationARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018
ARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018 Thomas F. Morley, DO, FACOI, FCCP, FAASM Professor of Medicine Chairman Department of Internal Medicine Director of the Division of Pulmonary,
More informationCOPD/ Asthma. Dr Heather Lewis Honorary Clinical Lecturer
COPD/ Asthma Dr Heather Lewis Honorary Clinical Lecturer Objectives To understand the pathogenesis of asthma/ COPD To recognise the clinical features of asthma/ COPD To know how to diagnose asthma/ COPD
More informationStudy No.: Title: Rationale: Phase: Study Period Study Design: Centres: Indication: Treatment: Objectives : Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More information